Healthcare Provider Details

I. General information

NPI: 1881656106
Provider Name (Legal Business Name): DAVID OKUBO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 W 9000 S
WEST JORDAN UT
84088-9345
US

IV. Provider business mailing address

1995 W 9000 S
WEST JORDAN UT
84088-9345
US

V. Phone/Fax

Practice location:
  • Phone: 801-566-9888
  • Fax: 801-566-9899
Mailing address:
  • Phone: 801-566-9888
  • Fax: 801-566-9899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number167054-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number167054-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: